History Taking

Question 1

What are signs?

Answer 1

Things you can see on a clothed patient

Question 2

What are symptoms?

Answer 2

Things you find out in the history

Question 3

What are the aim of history taking? (4)

Answer 3

Allow patient time to give an account of their symptoms
Obtain clarification and ask about related symptoms which may lead to a diagnosis
Understand patients perception and how it effects lifestyle
obtain background information on previous and ongoing medical problems and treatment

Question 4

Structure of medical history?

Answer 4

Present complaint (signs and symptoms)
History of presenting complaint
Past medical history
Allergies
Drugs
Family history
Social history

Question 5

What to do if a patient says they are allergic to penicillin but don’t know the details of the allergy as they found out as a child?

Answer 5

Write this in the notes
‘patient allergic to penicillin, doesn’t know details because episode as a child and never taken again, no more details available’

Question 6

How to ask about smoking?

Answer 6

Do you smoke?
Have you ever smoked?
When did you stop?
How many a day?

Question 7

Medical history?

Answer 7

CVS
Respiratory
GI
Neurological
Skin 
Do you have any other conditions

Question 8

Basic pain history?

Answer 8

SOCRATES
Site
Onset (how quickly did pain develop)
Character (dull/sharp)
Radiate (does it spread)
Associated factors
Timing
Exacerbating/relieving factors (paracetamol will only get rid of mild/moderate pain - take this into account for severity)
Severity (rate 1-10, does it effect sleep, does it effect day to day life)

Question 9

Is a pain scale on 1-10 a valid way to dictate severity of pain?

Answer 9

Yes
Pain is subjective
To that patent that is the severity of the pain

Question 10

If patient is taking pain relief what should you ask?

Answer 10

What it is?
When they took it?
Dose?
Where did they get it from?

Question 11

Common cause of chest pain?

Answer 11

Angina
Heart burn (GORD)
Pleuritic pain (pulmonary embolism) - well localised 
Musculoskeletal pain
Secondary to trauma 
Referred pain from abdomen

Question 12

What is angina?

Answer 12

Cardiac pain caused by impaired arterial supply to heart, resulting is schema at times of increased myocardial workload

Question 13

What is myocardial infarction?

Answer 13

Crushing central chest pain radiating from left arm
pain not relived with
associated with GTN nausea/sweating

Question 14

What is heartburn?

Answer 14

Oesophageal pain caused by regurgitation of gastric acid

Question 15

What is pleurisy (pleuritic chest pain)?

Answer 15

Pain from rubbing of inflamed pleural surfaces during respiration

Question 16

What is pulmonary embolism?

Answer 16

Sharp, plerutic chest pain, well localised

Check for sings and symptoms of deep vein thrombosis

Question 17

Risk factors for deep vein thrombosis?

Answer 17

Coagulation disorder causing patient to clot more than they should
Smoking
Immobility
History of pelvic Surgery/tumour
Pregnancy
Surgery
High levels of oestrogen